Tuesday, August 18, 2009

Eli Lilly Posts its Grand Deception

Eli Lilly has recently posted the Grand Deception which it is calling the "Lilly Faculty Registry." You can inspect it here. Why do I call it the "Grand Deception?" Because the doctors listed as "faculty" are not really faculty at all. They are salesmen and saleswomen, with MDs after their names. The Wall Street Journalreported that over the first three months of 2009, Lilly pumped $22 million into doctors' pockets, and most of this was categorized as "Healthcare Professional Education." This is the same kind of education you'll get if you go to a Toyota dealership and ask the salesman to educate you about which hybrid to buy. You will get some education, most of it accurate, about the Toyota Prius. You'll hear about its gas mileage, its cubic footage and its GPS system. But you won't hear anything about Honda hybrids or Ford hybrids or Chrysler hybrids. You won't be getting "car-buying professional education." You'll be getting a marketing pitch.

Lilly's Healthcare Professional Education events are no different. Doctors who go to a Lilly-sponsored talk on depression, for example, will hear plenty of information about Lilly's blockbuster Cymbalta, most of it accurate. But they'll hear nothing about Zoloft, or Celexa, or Paxil, or Effexor, or Remeron, or Nardil, or any of the dozens of other antidepressants that are as effective as Cymbalta.

Here's how Lilly defines Healthcare Professional Education: "Speaker programs are intended to enhance a healthcare professional's knowledge and patient care expertise." Excuse my calling a spade a spade here, but that's simply a lie, and every speaker on the registry list (many of whom are friends and colleagues) knows it. The speakers are required to use Lilly's slides, and are required to say what Lilly wants them to say. And what Lilly wants them to say are things that will get the doctors in the audience to prescribe more Lilly drugs.

Aren't I insulting the intelligence of doctors? Don't the doctors who go to these talks understand that it is a hard sell? Of course they do. But this knowledge does not make them impervious to the effects of marketing. Everybody knows that the billboards for Bud Light are paid for by Anheuser Busch. But that doesn't make them any less effective.

The question is, do we want our doctors to get their medical education this way? To be plied with good food, plentiful wine, and a free ticket to a colleague's joke-filled presentation singing the praises of the company's drug? Of course not.

Most importantly, do these talks lead to patients being harmed? Almost certainly. Lilly's top-selling drug, Zyprexa, led to an average weight gain of 37 pounds in a year in one study (Strassnig M et al. Schizophr Res 2007 Jul; 93:90-8.). Now that's not a study you'll be hearing much about during Lilly's Healthcare Professional Education talks!

12 comments:

Some of my friends at Emory are complaining that they lost their outside income from giving "promotional" talks when those were recently blocked. It is a sorry state of affairs that they were doing these talks and freely admitting that they were doing sales.

It's a little naive to presume that MD's are prescribing Zyprexa because of advertising with little thought as to the metabolic side effects. There isn't a physician out there -- let alone a 3rd year medical student -- who doesn't know that all the atypicals cause metabolic side effects, and that olanzapine is by far the worst offender. It's still a useful drug that has its place in treating psychiatric illness, just like every other drug we have that has harmful side-effects.

This blog not only succeeds in what I doubted a single author could accomplish -- the blog is, in fact, a useful and balanced overview of the state of medical education -- but also is exactly what the author promises a blog about the pursuit of excellence in medical education, construed above all in ethical terms.

Chartreuse--You're right that many doctors know about Zyprexa's liabilities as well as its putative advantages. The advantages are debatable and require a clear-headed discussion about the CATIE trial results and other studies, taking into account research methodology that could have stacked the deck in favor of Zyprexa. Lilly would never sponsor that kind of discussion. Any promotional speaker who brought the topic up as a key point would be summarily dismissed from the speaker's bureau. This does not constitute education, it is marketing.

Dan, I generally agree with your comments here. But here's a point about the slides: Lilly probably provided the slides to the speakers for the purpose of ensuring that the talks remained "on-label." I'd bet that the slides were vetted by a "MRL review" (medical-regulatory-legal). The company is trying to prevent overly enthusiastic speakers from making excessive efficacy claims or downplaying safety risks, because they know that FDA looks out for these events.

Disclaimer: I work for a pharma, but in R&D not marketing. No ties to any psychiatry drugs.

You will get some education, "most of it accurate",C'mon Danny, you can never call it straight. "Most of it accurate" , why do you add commentary like this, still trying to find a way to rationalize what the docs are doing (as unknowing participants). THe talks are far more toxic then not providing competitor information, minimizing side effects, promoting for uses with no evidence. The docs are far less naive and far more culpable than you suggest. STATA

Lilly actually calls on and gives samples of Zyprexa to OB/GYNs. I saw samples in an OB's sample closet. Giving a pt. Zyprexa without prompt followup would be almost as irresponsible as Lilly putting it there in the first place.